Brazilian Journal of Infectious Diseases最新文献_第2页

Tenofovir vs. entecavir in chronic hepatitis B: A retrospective cohort study of hepatocellular carcinoma risk in a tertiary hospital in southern Brazil 替诺福韦与恩替卡韦治疗慢性乙型肝炎：巴西南部一家三级医院肝细胞癌风险的回顾性队列研究。

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-12-17 DOI: 10.1016/j.bjid.2025.104603

Adriana Neis Stamm , Cristiane Valle Tovo , Andressa Noal , Camila Ubirajara Silva , Jaysa Pizzi , Pedro Moreno Fonseca , Dimas Alexandre Kliemann

Background

Chronic Hepatitis B Virus (HBV) infection remains a major global health burden, affecting approximately 296 million individuals worldwide and leading to significant morbidity and mortality due to cirrhosis and Hepatocellular Carcinoma (HCC). Although Nucleos(t)ide Analogues (NAs) such as Tenofovir Disoproxil Fumarate (TDF) and Entecavir (ETV) effectively suppress HBV replication, their comparative efficacy in reducing HCC risk remains controversial.

Methods

This retrospective cohort study analyzed HBV-monoinfected patients treated with either TDF or ETV at a tertiary hospital in southern Brazil between 2014 and 2021. Patients with co-infections (HIV, HCV), prior HCC diagnosis, liver transplantation, or others antiviral treatments, like lamivudine e/ou alfainterferon, were excluded. Data on demographics, treatment regimens, disease progression, and HCC incidence were extracted from institutional databases. Statistical analyses included Fisher's exact test and Poisson regression to determine Relative Risk (RR) and 95 % Confidence Intervals (95 % CIs).

Results

Of the 127 included patients, 66 (52 %) received TDF and 61 (48 %) received ETV. Over a 7-year follow-up period, 10 patients developed HCC – 8 in the ETV group (13.1 %) and 2 in the TDF group (3 %). In the raw analysis, TDF use was associated with a significantly lower risk of HCC progression (RR = 0.23, p = 0.057, 95 % CI: 0.05‒1.046). After adjusting for the variable’s cirrhosis/advanced fibrosis and age in the multivariate analysis, this association lost statistical significance (RR = 0.33, p = 0.18, 95 % CI: 0.068‒1.685). This indicates that the apparent protective effect of tenofovir may have been influenced by these variables and may have limited the statistical power of the adjusted model. Patients receiving ETV had a higher prevalence of advanced liver disease, including cirrhosis (64.7 % vs. 35.3 %, p < 0.05), hepatic encephalopathy (7 % vs. 2.4 %, p < 0.05), and portal hypertension (12.5 % vs. 3.4 %, p < 0.05). The incidence rate of HCC was 1.12 per 100 person-years (to be interpreted with caution due to limited follow-up data).

Conclusion

Treatment with TDF was associated with a lower risk of HCC compared to ETV in the bivariate analysis, but this association lost significance in the multivariate analysis. These findings suggest that the initially observed protective effect of TDF against hepatic carcinogenesis may have been partially explained by confounding factors (cirrhosis/advanced fibrosis and age), as well as reflecting the limited sample size. Further studies are warranted to provide a more robust comparative evaluation of antiviral therapies.

背景：慢性乙型肝炎病毒（HBV）感染仍然是全球主要的健康负担，影响全球约2.96亿人，并导致肝硬化和肝细胞癌（HCC）引起的显著发病率和死亡率。尽管核酸(t)类似物（NAs）如富马酸替诺福韦二氧吡酯（TDF）和恩替卡韦（ETV）能有效抑制HBV复制，但它们在降低HCC风险方面的比较疗效仍存在争议。方法：这项回顾性队列研究分析了2014年至2021年在巴西南部一家三级医院接受TDF或ETV治疗的hbv单感染患者。合并感染（HIV， HCV），既往HCC诊断，肝移植或其他抗病毒治疗（如拉米夫定或阿芬干扰素）的患者被排除在外。人口统计学、治疗方案、疾病进展和HCC发病率的数据从机构数据库中提取。统计分析包括Fisher精确检验和泊松回归，以确定相对风险（RR）和95%置信区间（95% ci）。结果：纳入的127例患者中，66例（52%）接受TDF治疗，61例（48%）接受ETV治疗。在7年的随访期间，10例患者发生HCC - ETV组8例（13.1%），TDF组2例（3%）。在原始分析中，TDF的使用与HCC进展风险显著降低相关（RR = 0.23, p = 0.057, 95% CI: 0.05-1.046）。在多变量分析中调整变量的肝硬化/晚期纤维化和年龄后，这种关联失去了统计学意义（RR = 0.33, p = 0.18, 95% CI: 0.068-1.685）。这表明替诺福韦的明显保护作用可能受到这些变量的影响，并可能限制了调整模型的统计能力。接受ETV治疗的患者有较高的晚期肝病患病率，包括肝硬化（64.7%比35.3%,p < 0.05）、肝性脑病（7%比2.4%,p < 0.05）和门脉高压（12.5%比3.4%,p < 0.05）。HCC的发病率为1.12 / 100人年（由于随访数据有限，需要谨慎解释）。结论：在双变量分析中，与ETV相比，TDF治疗与较低的HCC风险相关，但这种关联在多变量分析中失去了意义。这些发现表明，最初观察到的TDF对肝癌的保护作用可能部分由混杂因素（肝硬化/晚期纤维化和年龄）解释，并反映了有限的样本量。有必要进行进一步的研究，以提供更有力的抗病毒治疗的比较评价。

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引用次数: 0

Endocarditis risk stratification with scores: what about reproducibility? The case of NOVA and DENOVA scores for Enterococcus faecalis bacteremia 心内膜炎风险分层评分：可重复性如何？粪肠球菌菌血症的NOVA和DENOVA评分

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-12-12 DOI: 10.1016/j.bjid.2025.104605

Pierre Danneels , Floris Chabrun , Lucia Grandière-Pérez , Ali Touré , Vincent Dubée

Objectives

NOVA and DENOVA scores were developed to guide endocarditis risk assessment in Enterococcus faecalis Bacteremia (EfB), but some of their criteria may be open to interpretation. We aimed to evaluate their inter-rater reliability and feasibility.

Methods

Thirty-two physicians from four specialties involved in the management of endocarditis independently evaluated eight EfB patient records using the NOVA and DENOVA scores. Each score was applied eight times per case. Inter-rater reliability was measured with Krippendorff’s alpha, and agreement with Fleiss’ Kappa. Completion time was also recorded.

Results

No record received identical scores from all raters. NOVA showed low inter-rater reliability (α = 0.37), while DENOVA reached moderate levels (α = 0.49). High agreement was found for extreme score values, but agreement dropped markedly for intermediate values. Among score items, Auscultation of murmur (A) and Valve disease (V) had the highest reliability (α > 0.8), while Duration of symptoms (D) and Origin of infection (O) had the lowest (α < 0.2). Completion times were similar between NOVA and DENOVA but varied by specialty.

Conclusion

The reproducibility of these scores is limited, especially near critical thresholds, highlighting the need to complement scoring tools with clinical judgment in EfB.

目的建立nova和DENOVA评分来指导粪肠球菌菌血症（Enterococcus faecalis Bacteremia, EfB）的心内膜炎风险评估，但其中一些标准可能有待解释。我们的目的是评估它们的内部可靠性和可行性。方法来自心内膜炎4个专科的32名医生使用NOVA和DENOVA评分对8例EfB患者进行独立评估。每个评分在每个病例中应用8次。评估者间信度采用Krippendorff ' s alpha测量，并与Fleiss ' Kappa一致。完成时间也被记录下来。结果没有记录得到所有评分者相同的分数。NOVA的信度较低（α = 0.37），而DENOVA的信度为中等（α = 0.49）。极端值的一致性很高，但中间值的一致性明显下降。在评分项目中，听诊杂音(A)和瓣膜疾病(V)的可靠性最高（α < 0.8），而症状持续时间(D)和感染来源(O)的可靠性最低（α < 0.2）。完成时间在NOVA和DENOVA之间相似，但因专业而异。结论这些评分的可重复性是有限的，特别是在接近临界阈值时，突出了在EfB中补充评分工具和临床判断的必要性。

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引用次数: 0

Blood safety and epidemiological trends of blood-borne infections in Brazil: A retrospective analysis 巴西血液安全和血源性感染的流行病学趋势：回顾性分析

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-11-01 DOI: 10.1016/j.bjid.2025.104592

Rodrigo Guimarães Cunha , Elba Regina Sampaio de Lemos , Luiz de Melo Amorim Filho , Maria Esther Duarte Lopes , Marco Aurelio Pereira Horta , Renata Carvalho de Oliveira

The transfusion of blood components is a critical therapeutic intervention for certain clinical conditions for which alternative treatments are often unavailable. Despite the benefits, transfusions can pose health risks to the recipients, including potential transmission of infectious agents. Post-donation, blood components undergo testing for major transmissible agents such as Human Immunodeficiency Virus (HIV), Hepatitis B and C Viruses (HBV and HCV), Treponema pallidum (syphilis), and Trypanosoma cruzi (Chagas disease). This retrospective study assessed the prevalence of donor unsuitability due to these agents and examined potential influences on the profile of blood-borne infections among healthy blood donors in the region. This study was conducted at a public institution in Brazil from January 2014 to December 2021. All effective blood donations were included, totaling 600,001. The donor demographic profile was as follows: 60.5% male, 52.2% single, 44.5% self-identified as white, 39.6% completed high school, and the 31–40 year age group had the highest number of donors, comprising 28%, with the majority being regular donors (70.4%). The prevalence of hemotransmissible agents was 2.13% (T. pallidum), 1.54% (HBV), 0.44% (HIV), 0.36% (T. cruzi), 0.26% (HCV), and 0.23% (HTLV). Specific associations were noted among the sociodemographic data for each condition. T. pallidum and HBV infections are the most frequent causes of donor ineligibility. The data indicate that prevalence rates remained relatively constant with minor fluctuations throughout the study period, although the frequency of HIV infection was notably higher in 2021.

输血是一种关键的治疗干预措施，对某些临床条件，替代治疗往往是不可用的。尽管有这些好处，输血也可能给接受者带来健康风险，包括潜在的传染病传播。捐献后，对血液成分进行主要传染性病原体检测，如人类免疫缺陷病毒（HIV）、乙型和丙型肝炎病毒（HBV和HCV）、梅毒螺旋体（梅毒）和克氏锥虫（恰加斯病）。这项回顾性研究评估了由于这些药物导致的献血者不适宜的流行程度，并检查了该地区健康献血者中血液传播感染概况的潜在影响。本研究于2014年1月至2021年12月在巴西的一家公共机构进行。有效献血者60万人次。献血者的人口结构如下：60.5%为男性，52.2%为单身，44.5%为白人，39.6%为高中毕业，31-40岁年龄组的献血者最多，占28%，其中大多数是定期献血者（70.4%）。其中，梅毒锥虫感染率为2.13%，乙肝病毒感染率为1.54%，艾滋病病毒感染率为0.44%，克氏锥虫感染率为0.36%，丙型肝炎病毒感染率为0.26%，乙型肝炎病毒感染率为0.23%。在每种情况的社会人口统计数据中都注意到了特定的关联。梅毒螺旋体和乙肝病毒感染是导致供体不合格的最常见原因。数据表明，在整个研究期间，患病率保持相对稳定，波动较小，但2021年艾滋病毒感染频率明显较高。

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引用次数: 0

Identification and characterization of Staphylococcus spp. Isolated in co-infection with respiratory viruses from children in ICUs 重症监护病房患儿呼吸道病毒共感染葡萄球菌的鉴定与鉴定

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-10-24 DOI: 10.1016/j.bjid.2025.104591

Kelliane Martins de Araujo , Marcos de Oliveira Cunha , Vivian Maria Cordeiro , Angélica de Lima das Chagas , José Daniel Gonçalves Vieira , Celia Regina Malveste Ito , Thais Reis Oliveira , Lucas Candido Gonçalves Barbosa , Isabela Wastowski Jubé , Lilian Carla Carneiro

Healthcare-associated infections are among the most significant complications in hospitalized patients, posing a major challenge due to the antimicrobial resistance of pathogenic agents such as Staphylococcus spp. The study aims to identify and evaluate the phenotypic and molecular resistance profile of Staphylococcus spp. in co-infection with respiratory viruses, including COVID-19, as a respiratory virus, in samples from children admitted to ICUs. Nasopharyngeal samples from the biorepository were stored at -80 °C in medium containing gentamicin and amphotericin B. Bacterial strains were isolated, and antibiograms were performed using the Kirby-Bauer method with antimicrobials specific to Staphylococcus spp. and the method of evaluating molecular resistance, carrying out the amplification of resistance genes, using specific oligonucleotides. A multidrug-resistant profile was observed in Staphylococcus spp., highlighting the need for monitoring to ensure appropriate treatment. Antimicrobial resistance emphasized the importance of strict control over antibiotic use in hospital environments. This study contributes to the understanding of antimicrobial resistance in bacterial co-infections, providing insights for more effective treatments and HAI control strategies.

医疗保健相关感染是住院患者最重要的并发症之一，由于病原菌（如葡萄球菌）的抗微生物药物耐药性，对其构成了重大挑战。本研究旨在鉴定和评估葡萄球菌在与呼吸道病毒（包括COVID-19作为呼吸道病毒）共感染时的表型和分子耐药谱。生物库鼻咽标本在-80℃含庆大霉素和两性霉素b的培养基中保存，分离菌株，采用Kirby-Bauer法，葡萄球菌特异性抗菌药物和分子耐药性评价方法，利用特异性寡核苷酸扩增耐药基因，进行抗生素谱测定。在葡萄球菌中观察到多重耐药概况，突出了监测以确保适当治疗的必要性。抗菌素耐药性强调了严格控制医院环境中抗生素使用的重要性。本研究有助于了解细菌合并感染的抗菌药物耐药性，为更有效的治疗和HAI控制策略提供见解。

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引用次数: 0

Guideline for antimicrobial treatment of multidrug-resistant Gram-negative infections: practice recommendations of the Brazilian Society of Infectious Diseases 耐多药革兰氏阴性感染的抗菌治疗指南：巴西传染病学会的实践建议。

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-10-22 DOI: 10.1016/j.bjid.2025.104589

Alexandre Prehn Zavascki , Alberto Chebabo , Clovis Arns Cunha , Alexandre Rodrigues Silva , Gabriel Trova Cuba , Daniel Wagner C.L. Santos , Ana Cristina Gales

Although international guidelines are available, a national consensus is crucial to address the unique challenges faced in Brazil regarding the management of infections caused by multidrug-resistant Gram-negative bacilli (MDR-GNB). These challenges include marked regional disparities in antimicrobial access, variability in pathogen prevalence and resistance patterns, and unequal availability of diagnostic resources. This guideline, developed by a consensus of infectious diseases experts nominated by the Brazilian Society of Infectious Diseases, aims to support clinicians, particularly non-specialists, in the management of MDR-GNB infections across diverse healthcare settings in the country. The document focuses on pathogens classified as critical or high-priority by the World Health Organization (WHO), including Carbapenem-Resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA), ESBL- and AmpC-producing Enterobacterales, as well as Stenotrophomonas maltophilia, and Burkholderia cepacia. Therapeutic recommendations are organized by pathogen and infection site, including respiratory tract, skin and soft tissue, bloodstream, intra-abdominal, and both complicated and uncomplicated urinary tract infections.

尽管已有国际指导方针，但要解决巴西在耐多药革兰氏阴性杆菌（MDR-GNB）引起的感染管理方面面临的独特挑战，全国共识至关重要。这些挑战包括在获得抗微生物药物方面存在明显的区域差异，病原体流行率和耐药模式存在差异，以及诊断资源的可得性不平等。该指南是由巴西传染病学会提名的传染病专家协商一致制定的，旨在支持临床医生，特别是非专业医生，在该国不同卫生保健机构中管理耐多药- gnb感染。该文件重点关注被世界卫生组织（WHO）列为关键或高度优先的病原体，包括耐碳青霉烯类肠杆菌（CRE）、鲍曼不动杆菌（CRAB）和铜绿假单胞菌（CRPA）、产生ESBL和ampc的肠杆菌，以及嗜麦芽窄养单胞菌和洋葱伯克氏菌。治疗建议是根据病原体和感染部位组织的，包括呼吸道、皮肤和软组织、血液、腹腔内以及复杂和非复杂的尿路感染。

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引用次数: 0

An unusual association between HIV and Creutzfeldt-Jakob disease in a patient from northeastern Brazil 一名巴西东北部患者的HIV与克雅氏病之间的不寻常联系

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-10-11 DOI: 10.1016/j.bjid.2025.104590

José Wagner Leonel Tavares-Júnior , Francisco José Basílio , Francisco Edson Buhamra Abreu , Lucas Rodrigues Tomaz dos Santos , Pablo Picasso de Araújo Coimbra , Érico Antonio Gomes de Arruda

Prion diseases are significant contributors to rapidly progressive dementia. Among these conditions, sporadic Creutzfeldt-Jakob Disease (CJD) is the most prevalent, characterized by its rarity, lack of treatment options, and rapid progression to fatality. Diagnosis relies on a combination of clinical symptoms and specific alterations detected in brain MRI, EEG, and CSF analysis. The present study details the case of a 53-year-old individual from Fortaleza, Brazil, diagnosed with sporadic CJD, confirmed through clinical presentation and a series of diagnostic evaluations, including 14-3-3 protein detection and RT-QuIC analysis. Differential diagnoses were considered to rule out other rapidly progressing conditions, such as infectious and immune-related diseases, ultimately leading to a likely diagnosis of sporadic CJD.

朊病毒疾病是导致快速进展性痴呆的重要因素。在这些疾病中，散发的克雅氏病（CJD）最为普遍，其特点是罕见、缺乏治疗选择和迅速发展至死亡。诊断依赖于临床症状和在脑MRI、脑电图和脑脊液分析中检测到的特定改变的结合。本研究详细介绍了一名来自巴西Fortaleza的53岁患者，通过临床表现和一系列诊断评估（包括14-3-3蛋白检测和RT-QuIC分析）确诊为散发性克雅氏病。鉴别诊断被认为排除了其他快速发展的疾病，如传染性和免疫相关疾病，最终导致可能的散发CJD诊断。

引用次数: 0

Effectiveness of simplifying antiretroviral therapy to maintain viral suppression and improve bone and renal health: comparing simplified and non-simplified therapy 简化抗逆转录病毒治疗维持病毒抑制和改善骨骼和肾脏健康的有效性：简化和非简化治疗的比较

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-09-20 DOI: 10.1016/j.bjid.2025.104578

Juliana Olsen Rodrigues, Alexandre Naime Barbosa, Stephanie Valentini Ferreira Proença, Lenice Rosário de Souza

Objective

Nucleoside/nucleotide reverse transcriptase inhibitors, particularly tenofovir, can cause long-term side effects such as decreased bone mineral density and estimated glomerular filtration rate. A strategy to mitigate these effects is the simplification of antiretroviral therapy, which involves withdrawing one of the nucleoside/nucleotide reverse transcriptase inhibitors from the therapeutic scheme. While clinical trials and real-world studies have demonstrated that the simplified therapy maintains undetectable viral loads, its impact on bone mineral density and kidney function remains unclear owing to the lack of real-world evidence.

Methods

This retrospective cohort study compared 152 patients who underwent antiretroviral therapy simplification (primarily due to osteopenia, osteoporosis, or decreased estimated glomerular filtration rate) with 306 patients who maintained triple therapy, between April 2013 and September 2022. The simplified regimens included lamivudine plus dolutegravir or ritonavir-boosted darunavir. The groups were analyzed based on their demographic characteristics using Student's t-test in the case of symmetric data. Therapeutic success (undetectable viral load at the end of follow-up) was assessed using Kaplan Meier survival analysis. The estimated glomerular filtration rate variation before and after simplification was analyzed using the Mann-Whitney test. Pre-and post-simplification bone mineral density values were evaluated using the chi-square test for trends and assessed in the simplified therapy group. A significance level of 5% (α = 0.05) was adopted for all tests.

Results

Simplified antiretroviral therapy was non-inferior to triple therapy in maintaining undetectable viral load. Patients receiving simplified regimens showed a positive variation in estimated glomerular filtration rate. A small subset of patients also exhibited improvements in bone mineral density after antiretroviral therapy simplification.

Conclusions

These findings suggest that simplified therapy is as effective as triple therapy and has the additional benefit of reducing tenofovir-related adverse events.

核苷/核苷酸逆转录酶抑制剂，特别是替诺福韦，可引起长期副作用，如降低骨密度和肾小球滤过率。减轻这些影响的一种策略是简化抗逆转录病毒治疗，包括从治疗方案中撤出一种核苷/核苷酸逆转录酶抑制剂。虽然临床试验和现实世界的研究表明，简化疗法保持无法检测的病毒载量，但由于缺乏现实世界的证据，其对骨矿物质密度和肾功能的影响尚不清楚。方法：这项回顾性队列研究比较了2013年4月至2022年9月期间，152例接受简化抗逆转录病毒治疗的患者（主要是由于骨质减少、骨质疏松或肾小球滤过率降低）和306例坚持三联治疗的患者。简化方案包括拉米夫定加多替韦或利托那韦加达那韦。在对称数据的情况下，使用学生t检验对分组进行人口统计学特征分析。治疗成功（随访结束时未检测到病毒载量）采用Kaplan Meier生存分析进行评估。使用Mann-Whitney检验分析简化前后估计的肾小球滤过率变化。采用卡方检验对简化治疗前后的骨密度值进行趋势评估，并对简化治疗组进行评估。所有检验均采用显著性水平5% （α = 0.05）。结果简化抗逆转录病毒治疗在维持检测不到的病毒载量方面不逊于三联治疗。接受简化方案的患者在估计肾小球滤过率方面显示出积极的变化。一小部分患者在简化抗逆转录病毒治疗后也表现出骨矿物质密度的改善。结论这些发现表明，简化治疗与三联治疗一样有效，并具有减少替诺福韦相关不良事件的额外益处。

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引用次数: 0

Brazilian task force for the management of mucormycosis 巴西毛霉病管理工作队

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-09-19 DOI: 10.1016/j.bjid.2025.104579

Patrick Leon de Godoy Macedo , Mariane Taborda , Vítor Falcão de Oliveira , Adriana Satie Gonçalves Kono Magri , Lígia Lins Frutuoso , Gideane Mendes de Oliveira , Sinaida T. Martins , Daniel Wagner de Castro Lima Santos , Fabianne Altruda de Moraes Costa Carlesse , Francelise Bridi Cavassin , Kelsen Dantas Eulálio , Marcia Lazera Andréa , Andréa d’Avila Freitas , José Ernesto Vidal , Dayvison Francis Saraiva Freitas , Marcia Garnica , Terezinha do Menino Jesus Silva Leitão , Rosely Maria Zancopé-Oliveira , Marcia de Souza Carvalho Melhem , Flavio Queiroz Telles , Marcello Mihailenko Chaves Magri

Background

Mucormycosis is a rare but life‑threatening fungal infection that has shown an increased incidence in Brazil, especially during the COVID‑19 pandemic.

Objective

To provide an evidence‑based, context‑specific guideline for the diagnosis and management of mucormycosis within the Brazilian healthcare system. Clinical features: Rhino‑orbito‑cerebral disease predominates, followed by pulmonary, cutaneous, gastrointestinal and disseminated forms; delayed recognition dramatically increases mortality.

Epidemiology

The global incidence of mucormycosis is increasing, particularly among patients with diabetes mellitus, hematologic malignancies, transplantation, and corticosteroid exposure. The most frequently isolated species is Rhizopus arrhizus, and regional variations in species distribution may be present. In Brazil, comprehensive epidemiological data remain scarce.

Treatment

Early, aggressive surgical debridement plus induction with liposomal amphotericin B (5–10 mg/kg/day) followed by isavuconazole or posaconazole is recommended; strict control of hyperglycemia and immunosuppression is essential.

Conclusion

Standardized national guidance, improved rapid diagnostics, systematic surveillance and equitable drug availability are critical to reduce Brazil’s mucormycosis burden.

毛霉病是一种罕见但危及生命的真菌感染，在巴西的发病率有所上升，特别是在COVID - 19大流行期间。目的为巴西卫生保健系统中毛霉病的诊断和管理提供一个基于证据的、具体情况的指南。临床特征：以鼻眶型脑疾病为主，其次为肺部、皮肤、胃肠道和弥散性疾病；认知延迟会显著增加死亡率。全球毛霉病的发病率正在增加，特别是在糖尿病、血液恶性肿瘤、移植和皮质类固醇暴露的患者中。最常被分离的种是阿根霉，在种分布上可能存在区域差异。在巴西，全面的流行病学数据仍然很少。早期，建议积极的手术清创加两性霉素B脂质体诱导（5-10 mg/kg/天），随后使用异磺康唑或泊沙康唑；严格控制高血糖和免疫抑制是必要的。结论标准化的国家指导、改进的快速诊断、系统监测和公平的药物可及性对减轻巴西毛霉病负担至关重要。

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引用次数: 0

The impact of a multidisciplinary team on the management of fracture-related infections: A surveillance study in Brazil 多学科团队对骨折相关感染管理的影响：巴西的一项监测研究

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-09-11 DOI: 10.1016/j.bjid.2025.104576

Icaro Santos Oliveira , Carlos Augusto Finelli , Taiana Cunha Ribeiro , Carolina Coelho Cunha , Thomas Stravinskas Durigon , Rodrigo Peixoto Vargas , Rafael Brull Tuma , Giselle Burlamaqui Klautau , Fernando Baldy dos Reis , Mauro Jose Salles

Background

Fracture-Related Infection (FRI) is an increasing and challenging complication following orthopedic trauma surgery. Preventive and microbial diagnostic measures vary significantly particularly in low- and middle-income countries. The objectives of this national questionnaire were to investigate clinical practices towards preventive and diagnostic strategies adopted by Brazilian orthopedic trauma centers and to assess the impact of Multidisciplinary Teams (MDT) on the management of FRI.

Methods

A 34-item electronic questionnaire was developed via REDCap® and distributed to all trauma surgeons registered of the Brazilian Society of Orthopedics and Traumatology (SBOT).

Results

With a response rate of 24 %, the survey was fully responded by 140 trauma surgeons, 63.6 % of them working in southeast region centers. Collaborative work with MDT focused on musculoskeletal infections was reported by only 41.0 %. Cephalosporins were universally prescribed as Perioperative Antibiotic Prophylaxis (PAP), while association with an aminoglycoside increased (35.0 %) for severe open fracture. One-day duration of PAP for closed fracture was prescribed in 68.1 %, while it often exceeded current recommendations. Diagnostic practices for FRI patients were primarily based on clinical signs and standard radiological and laboratory tests, with limited use of microbiological techniques. Trauma services working collaboratively with MDT significantly improved FRI management, including, use of sonication fluid for diagnosis (46.6 % vs. 26.8 %; p = 0.02), body weight-adjusted antibiotic dosing for PAP (50.0 % vs. 24.4 %; p = 0.02), appropriate duration of PAP according to the severity of soft-tissue damage (80.7 % vs. 59.3 %; p = 0.01), infection risk stratification in elderly patients with fractures (45.6 % vs. 21.0 %; p < 0.001), use of negative-pressure wound therapy (87.9 % vs. 54.9 %; p < 0.001) and regular collaboration with orthoplastic surgeon (44.8 % vs. 17.5 %; p = 0.01).

Conclusions

This national survey revealed marked heterogeneity in FRI management across Brazilian trauma services. Ongoing MDT collaboration improved clinical practice, especially diagnostic work-up and antimicrobial stewardship.

背景：骨折相关感染（FRI）是骨科创伤手术后越来越多且具有挑战性的并发症。预防和微生物诊断措施差别很大，特别是在低收入和中等收入国家。这项全国性问卷调查的目的是调查巴西骨科创伤中心采用的预防和诊断策略的临床实践，并评估多学科团队（MDT）对frid管理的影响。方法通过REDCap®开发了一份34项的电子问卷，并分发给在巴西骨科和创伤学会（SBOT）注册的所有创伤外科医生。结果140名创伤外科医生全面回复问卷，回复率为24%，其中63.6%在东南地区中心工作。与MDT合作治疗肌肉骨骼感染的比例仅为41.0%。头孢菌素被普遍用作围手术期抗生素预防（PAP），而在严重开放性骨折中与氨基糖苷的相关性增加（35.0%）。68.1%的患者使用PAP治疗闭合性骨折，但其使用时间经常超过目前的建议。FRI患者的诊断实践主要基于临床症状和标准放射学和实验室检查，微生物学技术的使用有限。创伤服务与MDT合作显著改善了FRI管理，包括使用超声液进行诊断（46.6%对26.8%,p = 0.02），根据体重调整PAP的抗生素剂量（50.0%对24.4%,p = 0.02），根据软组织损伤严重程度适当的PAP持续时间（80.7%对59.3%,p = 0.01），老年骨折患者的感染风险分层(45.6%对21.0%；P < 0.001)，使用负压伤口治疗（87.9%对54.9%;P < 0.001）和定期与矫形外科医生合作（44.8%对17.5%;P = 0.01）。结论：这项全国调查揭示了巴西创伤服务部门在FRI管理方面的显著异质性。正在进行的MDT合作改善了临床实践，特别是诊断检查和抗菌药物管理。

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引用次数: 0

Molecular characterization of Human T-cell Lymphotropic Viruses 1 and 2 (HTLV-1 and HTLV-2) in samples from blood donation candidates in the state of Pará, Brazilian Amazon 巴西亚马逊帕尔<e:1>州候选献血者样本中人类t细胞嗜淋巴病毒1和2 （HTLV-1和HTLV-2）的分子特征

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-09-10 DOI: 10.1016/j.bjid.2025.104577

Carolina Alcântara Maneschy , Patricia Santos Lobo , Carlos Eduardo de Melo Amaral , Katarine Antonia dos Santos Barile , Jairo Augusto Americo de Castro , Rodrigo Vellasco Duarte Silvestre , Felipe Bonfim Freitas , Luana Silva Soares , Sylvia Fátima Santos Guerra

The Human T-Lymphotropic Virus (HTLV) is a retrovirus belonging to the Retroviridae family and the Deltaretrovirus genus, which has a tropism for T lymphocytes. Despite being the first human retrovirus identified, knowledge about its infection remains limited, highlighting the need for further research, especially in Northern Brazil.. This study aimed to phylogenetically characterize HTLV-1 and HTLV-2 samples identified in blood donors from the state of Pará. The phylogenetic characterization was performed using DNA samples from blood donors at the HEMOPA Foundation, collected between January 2015 and December 2021. The 5′LTR regions of HTLV-1 and HTLV-2 were amplified using specific primers with Nested PCR. The amplified products were purified and sequenced using the dideoxynucleotide method, with the same primers used in the Nested PCR, for subsequent phylogenetic analysis and the construction of a sequence database, as well as deposits in GenBank. The phylogenetic analysis of the 5′LTR sequences of HTLV-1 from this study, compared with isolates available in GenBank, showed that 100 samples clustered with Cosmopolitan subtype isolates, Transcontinental subgroup, while 2 samples clustered with Cosmopolitan subtype isolates, Japanese subgroup. Regarding the phylogenetic analysis of HTLV-2 from this study in comparison with other GenBank isolates, most of the isolates clustered with strains described as HTLV-2c, and only three samples clustered with strains described as HTLV-2a. The epidemiological profile found in the analyzed samples consisted mainly of women, with an average age of 40 years and a low level of education. The molecular characterization of the viral genome provides information about the viral subtypes circulating in the population. This information may be important for increasing investments in screening and monitoring individuals infected with HTLV, thereby contributing to prophylactic practices related to infection and the dissemination of knowledge about HTLV.

人类嗜T淋巴病毒（HTLV）是一种逆转录病毒，属于逆转录病毒科和德尔塔逆转录病毒属，对T淋巴细胞有亲和性。尽管这是第一个发现的人类逆转录病毒，但对其感染的了解仍然有限，这突出表明需要进一步研究，特别是在巴西北部。本研究旨在从par州的献血者中鉴定HTLV-1和HTLV-2样本的系统发育特征。系统发育特征是使用2015年1月至2021年12月期间在HEMOPA基金会收集的献血者的DNA样本进行的。利用巢式PCR扩增HTLV-1和HTLV-2的5′ltr区。使用巢式PCR中使用的相同引物对扩增产物进行纯化和测序，用于随后的系统发育分析和序列数据库的构建，并存入GenBank。对HTLV-1的5′ltr序列进行系统发育分析，并与GenBank中的分离株进行比较，结果表明，有100个样本属于Cosmopolitan亚型（Transcontinental亚群），2个样本属于Cosmopolitan亚型（Japanese亚群）。本研究HTLV-2与其他GenBank分离株的系统发育分析结果显示，大部分分离株与HTLV-2c菌株聚集在一起，只有3个样本与HTLV-2a菌株聚集在一起。在分析样本中发现的流行病学概况主要由女性组成，平均年龄为40岁，受教育程度较低。病毒基因组的分子特征提供了在人群中传播的病毒亚型的信息。这一信息对于增加筛查和监测HTLV感染者的投资可能是重要的，从而有助于与感染有关的预防措施和HTLV知识的传播。

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引用次数: 0